Frozen Shoulder High Volume Capsular Distention and Hydrodilation Procedure

Capsular distention and hydrodilation is a relatively new type of procedure performed for the treatment of frozen shoulder. Under ultrasound guidance, large volumes of sterile saline are injected into the glenohumeral joint. The pressure of the fluid distends the joint capsule. The adhesions are stretched to their breaking point and often rupture. This results in an increase in range of motion and mobility.


It is very important to aggressively work on passive and active range of motion within 2-3 hours of the procedure. There are two reasons for this.


First, local anesthesia is injected into the glenohumeral joint. This provides significant pain relief which allows for aggressive range of motion work.


Second, the fluid injected into the glenohumeral joint continues to distend the joint capsule. This will allow greater range of motion. The goal is to increase range of motion as much as possible during this critical period.


Many recent studies tout the benefits of high volume capsular distention. A systematic review and meta-analysis published in the American Journal of Sports Medicine (Zhang et al, 9/2020) compared multiple treatment options for frozen shoulder. They found that high volume capsular distention had the highest rank for pain relief and functional improvement.



Patient instructions

  1. Schedule your initial visit with physical therapy. They will establish a baseline of your strength, mobility, and range of motion.

  2. Schedule subsequent visits with physical therapy, approximately twice a week.

  3. Once you have your physical therapy schedule, call Dr Peng’s office to schedule your capsular distention procedure. Make sure it is within 2-3 hours of your next physical therapy appointment.

  4. Have the capsular distention procedure done and go to physical therapy for aggressive range of motion work.

  5. Continue to go to physical therapy. Work on range of motion exercises at home at least three times a day.

  6. Follow up with Dr Peng 4 weeks from your procedure date.

© 2020 by Jeffrey Peng MD